For treatment-resistant depression (TRD), a panel of 10 psychiatrists reached strong consensus on recommending augmentation with second-generation antipsychotics, transcranial magnetic stimulation, and ketamine/esketamine as next-step treatments after three failed antidepressant trials. Treatment preferences shifted to include nonaugmentative antidepressants and electroconvulsive therapy depending on patient characteristics such as metabolic disease and age. The findings underscore the importance of tailoring TRD treatment strategies to individual patient factors beyond conventional guideline tiers.
Bipolar disorder affects about 40 million people worldwide, with depression as its most disabling phase. Current treatments often work slowly, prompting interest in psilocybin, a psychedelic compound being studied in clinical trials combined with psychotherapy. Early research in bipolar II disorder (19 participants) shows encouraging results, but evidence is limited. Safety concerns include risk of mood switching and drug interactions. Regulatory hurdles, infrastructure needs, and uncertainties about the role of the psychedelic experience, especially with common bipolar medications, remain. Cautious research is needed to assess psilocybin's safety and efficacy for bipolar depression, particularly for bipolar I disorder and long-term outcomes.